MEDICARE: ELLEN COHEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	27800	NY

General Provider Information

NPI Number	:	1891953220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN COHEN

Provider Business Mailing Address
First Line	:	60 S MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3542
Country	:	US
Telephone Number	:	845-634-6207
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 S MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3542
Country	:	US
Telephone Number	:	845-634-6207
Fax Number	:

Authorized Official
Title or Position	:	SOLO PRACTIONER
Name	:	MS. ELLEN S COHEN
Credential	:	C.S.W.
Telephone Number	:	845-634-6207

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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